Provider Demographics
NPI:1700956414
Name:WELLY, CHARLES W (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:WELLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-342-2193
Practice Address - Street 1:5 W BACK ST STE 101
Practice Address - Street 2:
Practice Address - City:FINCASTLE
Practice Address - State:VA
Practice Address - Zip Code:24090-4368
Practice Address - Country:US
Practice Address - Phone:540-769-3964
Practice Address - Fax:540-473-3458
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2248207Q00000X
VA0102204907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine